Though variations in dental development are not uncommon, dental anomalies are rarer in primary dentition than in permanent dentition. Diagnosing such anomaly remains a challenge for the clinician. Primary mandibular first molars usually have two roots-mesial and distal. This article is a report of two cases with atypical crown and root morphology of the primary mandibular first molars. Both cases discussed had a bilateral crown and root variations where 3 roots were found in the primary mandibular first molars. All the teeth reported in this case report had a broader occlusal table resembling a primary maxillary molar, which posed a challenge during the dental treatment and required certain modifications from the routine procedures. The article focuses on diagnosis and modifications in the routine clinical procedures to be followed for such cases. The article also emphasizes the importance of preoperative radiographs in alerting the clinician to the presenting clinical challenge.
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